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• W103392647 abstract "'THERE IS MORE TO SUPERVISED EXERCISE THAN EXERCISE ITSELF'A Mixed Methods Study of Supervised Exercise with the Chronic Disease SelfManagementProgram for People with COPDChronic obstructive pulmonary disease (COPD), a progressive respiratory condition,significantly affects the lives of those managing its daily impact. Exercise isrecognised as an important management strategy. This thesis investigates theaddition of supervised exercise to the Stanford Chronic Disease Self-ManagementProgram (CDSMP) in people with COPD. The CDSMP is a group-based programdesigned to facilitate the acquisition of self-management skills, and does not have anexercise component.This thesis provides opportunity to consider theories of health behaviour change andthe role of self-efficacy in the self-regulation of behaviours, such as exercise. Theeffect of the CDSMP on self-reported exercise was reviewed, finding a lack ofpublished research concerning supervised exercise with the CDSMP.To investigate the effect of supervised exercise with the CDSMP older adults wereallocated to the CDSMP, with or without supervised exercise, in a parallel grouprandomised controlled clinical trial with a pre/post test design over two years. Amixed methods approach was used to provide a more detailed analysis of the effectof supervised exercise than one method alone, giving quantitative evidence enrichedby the lived experience of participants. Objective outcomes included physicalcapacity (primary outcome), self-reported exercise, stage of change for exercise,exercise self-efficacy, shortness of breath, heath-related quality of life and self managementbehaviours. Change in outcomes between groups and within group wasmeasured by appropriate statistical tests. Qualitative methods of enquiry using semistructuredinterviews and thematic analysis uncovered the lived experience of thepeople who participated in the CDSMP with or without supervised exercise. Eighty-four participants were randomised. There were 15 withdrawals, due to ill healthand other commitments. This thesis demonstrated a small statistically significant increase in physical capacity for the intervention and control groups, butno significant difference between them. However, the clinical significance of thewithin-group change was not reached. Further research is required in this area. Therewere no significant differences between groups for any secondary outcome, althoughanalysis of effect sizes indicated that supervised exercise confers a benefit to thosewho participate: they exercised more frequently, for longer duration, had lessbreathlessness and improved quality of life physical component summary comparedwith those who did not have supervised exercise. However, neither one hour ofweekly supervised exercise, in the absence of a structured home programme, nor theCDSMP alone, was sufficient to produce more than small improvements inoutcomes.Qualitative findings revealed participants bring to healthcare interactions a personalmeaning of self-management defined by their lived experiences and strategiesdeveloped in response to living with COPD. Similar sources of motivation act acrossthe CDSMP and supervised exercise, thereby supporting the construct of selfefficacyand signifying the pivotal role of perceived personal control as a mediator ofbehaviour change. However, the experience was not viewed positively by all,indicating the need to be alert to possible adverse psychological effects ofinterventions and to identify at-risk individuals. Participants endorsed supervisedexercise, emphasising the importance of respecting their preferences. This study suggests that the process of facilitating behaviour is not concerned with'who knows best', but rather with how the interaction between health professionaland participant facilitates a consideration of self and the best possible behaviours tomanage life with long-term health conditions, pointing to a framework forparticipant-centred engagement in healthcare.In conclusion, supervised exercise of one hour per week does not need to be anintegral component of the CDSMP, but offered as an optional adjunct, underpinnedby a participant-centred approach. Methods of increasing the clinical significance ofthe small increase in distance walked need to be explored." @default.
• W103392647 created "2016-06-24" @default.
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• W103392647 date "2009-01-01" @default.
• W103392647 modified "2023-09-27" @default.
• W103392647 title "There is more to supervised exercise than exercise itself : a mixed methods study of supervised exercise with the chronic disease self-management program for people with COPD" @default.
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